Can life after a stroke help with rehabilitation?

Life after a stroke is a separate page that every person affected by this disease must turn one day. Few of the victims and their relatives are ready to endure with dignity all the hardships with which it is associated.

However, life takes its toll, and you need to learn to cope with immobilization, constant rehabilitation procedures, stress, and depression.

Ischemic stroke

It is otherwise called a cerebral infarction. The disease affects most people aged 50-60 years. This is the most common stroke, it is considered to be “safer” than others, as far as this word is generally applicable to such a disease. Ischemic stroke is caused by two conditions:

1. Thrombosis - due to the formation of blood clots in the arteries, the access of blood saturated with oxygen is blocked, small vessels become clogged, and cells that do not receive recharge quickly die, necrosis begins. This happens more often at night.
2. Embolism - due to irregular contractions of the heart, the clots that form due to this enter the brain and block small vessels. This causes cells to die and turns brain tissue necrotic. This type of stroke often recurs.

To prevent ischemic stroke and not get sick, it is recommended, upon reaching the appropriate age, to regularly (every six months) check your heart function and monitor the health of your blood vessels.

How does sleep become normal?

To normalize sleep, doctors advise:

• Ventilate the room more often to keep the temperature low, or use air conditioning.
• It won’t hurt to reduce the amount of calories you consume and reduce the temperature of the food you eat.
• Extend wakefulness during the day. The patient will be able to be occupied with rehabilitation games aimed at improving memory and pronunciation.

To treat asthenic syndrome, patients after a stroke are prescribed: vitamins, drugs that stimulate metabolic processes in neurons, and psychostimulants.

It is necessary to ensure natural sleep duration at night. To do this, follow these instructions:

• The room in which the patient is located should be as well ventilated and darkened as possible.
• Position patients in bed on the healthy side or on their back.
• To restore normal biorhythms, the specialist prescribes melatonin.
• Natural sleeping pills and prescription drugs are used.
• Before going to bed, you can drink warm milk and honey.

During the daytime, certain efforts must be made to activate the patient’s condition:

• Exercise therapy or massage.
• Procedures that restore memory and speech function.
• Washing in cool water, personal hygiene.
• You need to listen to music.
• Eating more frequently in fractional portions, foods should not be too hot.
• Breathing exercises.

Intracerebral hemorrhage

This disease accounts for 10% of all strokes and affects the younger category of people - 50-55 years old. With it, as the name implies, blood enters the brain due to increased pressure in blocked parts or hypertension. They cause intracerebral hemorrhage and inflammatory processes affecting the cardiovascular system.

The nature of hypersomnia and insomnia

After a stroke, it often happens that the patient suffers from either hypersomnia (excessive desire to fall asleep) or insomnia.

Hypersomnia is characterized by very long sleep (12-14 hours a day), as well as a persistent desire to fall asleep.

For example, a patient may doze off in the most inappropriate situations - in a supermarket, at the stove in the kitchen, and so on.

The phenomenon of hypersomnia is a natural reaction of the body to stress.

Sleep is necessary for the body to cleanse cells of their own waste during wakefulness. This applies primarily to those cells that are located in the brain, since it is in this part of the body that the greatest work occurs at the cellular level.

So, after a stroke, the body ceases to understand how “polluted” the brain is: due to impaired blood circulation, the brain may think that the channels are clogged with products of cell activity, when in fact this is not true. It releases melatonin (the hormone of sleepiness), and the person wants to sleep.

Read also: Bleeding for stroke

Often, instead of abnormally long sleep, insomnia appears. The reasons in this case are slightly different: sensing danger, the brain overly activates the amygdala, which is responsible for aggression, defense, and so on. It is difficult for the brain to understand that the cause of a stressful state is not outside, but inside the body itself, so it reacts as if to an “external” enemy.

Coupled with the patient’s natural experiences and depressive states, the amygdala becomes even more active. And because of this, the patient falls asleep extremely poorly and often does not sleep at night.

Important. In addition to the above, poor blood circulation directly affects the desire to sleep. If a person has experienced a lack of blood circulation, he may feel sleepy, because in a state of sleep the body consumes fewer resources to maintain vital functions. In other words, the body protects itself in this way.

If the patient has suffered a hemorrhage, the temporarily remaining excess blood in the skull leads to excessive stimulation of the nerve tissue. The result is insomnia.

Subarachnoid hemorrhage

This stroke is manifested by the formation of hematomas between the brain and its membrane due to ruptures of the vessels of the latter. This type of disease also occurs in people over 30 years of age. There are many reasons for it, and most of them arise from the fault of the person himself:

• Alcohol, including single overdose,
• Smoking,
• Overweight,
• Injury,
• Excessive physical activity.

In addition to the above, subarachnoid stroke also occurs from arterial hypertension. Symptoms of the disease may appear 2 weeks before the actual attack.

Sleep during the post-stroke recovery period

A stroke affects different parts of the brain, cutting off access to blood, and therefore oxygen and nutrients. As a result, the cells in the affected area die. The so-called shadow area after a stroke is highlighted separately, the cells in which were not completely deprived of nutrition and oxygen, were partially damaged, but were able to “survive”. After an attack, they are attacked by dead cells in the affected area and, because of this, the risk of their rapid death increases.

The main role of sleep in the human body is restoration. During wakefulness, the body, roughly speaking, “wears out” cells. When he sleeps, everything happens the other way around, all systems of the human body slow down, and each cell restores its function. An increased amount of sleep means one thing - the body is trying to recover as much as possible after such a “blow”.

If the sleep is deep, occurs at night, lasts a long time, and after several months of rehabilitation it returns to relative normality - that is, the patient sleeps a sufficient number of hours - 8-10, and not 12-15, this is considered the norm. This means that the person is actively recovering, and there is a high chance of rapid improvement.

Causes of drowsiness

Very often, relatives and friends cannot understand why after a stroke the patient sleeps all the time.
In fact, there is no reason for anxiety - this is how the body tries to recover from a brain catastrophe.

Therefore, there is nothing alarming about constant sleep.

Let's take a closer look at the reasons why this happens.

Doctors identify three main factors that influence the daily routine after a stroke:

1. Not restored blood circulation in the body. The brain, on whose work almost everything in the body depends, must promptly renew the blood; if this does not happen, it sends appropriate signals to the body. The release of the hormone cortisol, which is responsible for stressful conditions, and a decrease in the production of serotonin , the main “calming” hormone, all impair sleep. A person begins to wake up to any rustle, which is why the body does not have time to fully rest. As a result, the duration of sleep increases.
2. The patient is depressed. Depression that occurs for physiological reasons is impaired reuptake of serotonin. This means that the level of this hormone, important for calm, drops significantly, and the person becomes apathetic. In this regard, suicidal thoughts often develop against the background of depression. A deteriorating condition, increased anxiety and similar factors affect the immune system and the quality of sleep, which ultimately leads to daytime and very long naps.
3. Age. If the patient is over 60 years old, a stroke weakens an already worn-out body. As a result, the physiological deficiencies accumulated in the body, such as tachycardia, lack of calcium in the bones, and so on, only worsen. The body needs more time to recover, which is why a stroke survivor may sleep 12-14 hours a day.

Please note: there may be many more reasons why a patient’s sleep pattern has changed. Often he gets confused due to increased stress, due to an unusual schedule in the hospital, due to a refusal to eat his previous diet, and so on.

The only thing that will really help to correctly determine the cause of the disorder is a consultation with a doctor. Correct diagnosis, in turn, will help to correct the patient’s regimen as quickly as possible.

Sleep abnormalities during rehabilitation after a stroke

It's much worse when you have problems sleeping. Often, the patient’s relatives do not notice sleep disturbances due to other serious consequences: speech, vision or hearing disorders. This is completely in vain. Ignoring sleep problems leads to delayed rehabilitation and a decrease in its effectiveness.

What sleep problems exist?

1. It happens that the patient actually sleeps a lot during the day. This is not a two or three hour rest, but a whole day in a comatose state. Such sleep is superficial, easily interrupted and does not bring the desired relief. It indicates that a person sleeps very poorly at night or wakes up very often, so the recovery processes are not completed. At the same time, shallow daytime sleep also does not provide sufficient rest, which means that rehabilitation worsens significantly. Sleep is disrupted because the area responsible for sleep is damaged during a stroke. The mechanism for falling asleep and waking up is broken. In this case, the only way to help is with medication.
2. An elderly patient may not recover sufficiently due to senile sleep. It is characterized by frequent awakenings, shallow and restless sleep. In this case, a person cannot get a good night's sleep, either during the day or at night.
3. Poor sleep may also be due to depression. The reason for it is obvious - pain, fear of illness, recurrent stroke, feeling of uselessness and other worries. Emotional disturbances can also occur due to clouding of consciousness after a stroke.

Constantly not getting enough sleep after a stroke is a bad sign. Relatives who care for the patient must take mandatory measures to eliminate this problem. To do this, you should definitely consult a doctor who will prescribe a course of medication for this problem, taking into account the cause of its occurrence.

Self-medication while taking a large number of pills for rehabilitation after a stroke is contraindicated - there is a high risk of causing drug incompatibility.

Consequences

A stroke is dangerous due to its consequences:

• Motor disorders. In severe cases, complete immobilization and paralysis are observed, and the person becomes bedridden. In milder cases there is a violation of the range of motion of joints, gait, and muscle weakness. Convulsions and involuntary movements of the hands are noted.
• Impaired coordination of movements. A person cannot maintain balance, falls, and cannot support his body even when sitting.
• Sensitivity disorders. The patient feels a burning sensation, numbness, and tingling in the limbs. In some cases, he does not feel any pain when touched, pricked, or burned.
• Deterioration in the functioning of the sensory organs. There is weakening of vision and hearing. With severe pathology, the patient may remain blind.
• Weakening of cognitive, thinking functions, speech. A person becomes distracted, inattentive, suffers from memory disorders, loses the ability to analyze, critically relate to the world around him, perform mathematical operations, and read. With extensive lesions, complete loss of cognitive abilities is possible. Patients often live in their own world. There is a loss of speech, the ability to speak, and to understand words addressed to him. Such disorders manifest themselves mainly in left-sided lesions.
• Emotional disorders. A person suffers from depression and hopelessness. Many patients become aggressive. This happens due to loss of control on the part of the left hemisphere.
• Disorders of the pelvic organs. There is urinary incontinence, involuntary defecation, or, conversely, constipation.
• Development of chronic diseases. The heart, respiratory organs, gastrointestinal tract, and kidneys suffer.
• Loss of ability to care for oneself. Due to the inability to move, to be critical of one’s actions, and loss of self-control, the patient often needs constant care.

Preventive measures to improve sleep

It is worth noting: if a patient after a stroke sleeps all the time, the sleep is of high quality and deep, there is no need to worry. If he sleeps during the day and is awake at night, this schedule can be slightly adjusted with the help of a doctor.

Let us highlight a number of simple methods that will require only a little effort from relatives looking after the patient:

• General temperature in the room. Normal temperature should reach a maximum of 20 degrees, and preferably a little lower. In the heat, a person has trouble falling asleep, loses moisture, tosses and turns and suffers. If you normalize this indicator, sleep will come easier. If the patient is cold, it is worth adding blankets, but still lower the air temperature.
• Lack of oxygen. It is recommended to ventilate the room regularly. If there is enough oxygen, then it is easier to fall asleep, and the patient’s body will recover better.
• It is worth feeding the patient warm, hot, fatty (moderate) food. Hearty food puts you to sleep and relaxes your body. If the patient does not eat and, moreover, drinks poorly, it is recommended to consult a doctor within two days. This may indicate a problem with swallowing or other digestive functions, which can lead to severe dehydration and starvation.
• It is worth setting a schedule - during the day, engage the patient in entertaining games, reading (if necessary out loud), listening to music, and so on. Establish the correct routine of rehabilitation procedures that will allow the patient to get tired only in the evening and successfully fall asleep.

Often the cause of prolonged sleep after a stroke is suspiciousness. This is a serious illness that greatly affects each person who experiences the attack. Some patients become overly concerned with themselves and feel that no matter how much sleep they get, it is still not enough. In this case, it is worth gently explaining to the person that there are certain norms of sleep at the right time of day, and they are enough for recovery. If this does not help, it is better to consult a doctor or psychologist who will try to explain this to the patient.

How to treat at home

After treatment procedures in the hospital and improvement of the patient’s condition, the patient is discharged for further recovery. The first 6 months after discharge are at high risk of a recurrent attack. During home treatment, aimed not only at rehabilitation, but also at preventing complications and relapse, the most effective drugs are used:

1. Antidepressants. A patient who has suffered a stroke is subject to frequent attacks of fear, anxiety, and nervous agitation. To eliminate negative symptoms associated with brain disorders, sleeping pills and antidepressants (Paxil, Mianserin, Mirtazapine) are prescribed.
2. Antiplatelet agents. To prevent the development of thrombus formation, patients after a stroke must constantly take medications to thin the blood (Aspirin, Curantil, Clopidogrel). They gently, unlike anticoagulants, prevent platelets from sticking together.
3. Painkillers. In the post-stroke period, pain occurs quite often. The best solution for their relief is taking painkillers (Aspirin, Analgin, Ketanov).
4. Anticonvulsants. Against muscle spasms, which can develop against the background of disorders of brain activity, drugs of different directions are prescribed: normalizing the functioning of the central nervous system, reducing the activity of nerve cells and stopping muscle contractions.
5. Nootropics. To eliminate cognitive impairment, as well as restore memory and attention, drugs are used that activate the functioning of nerve cell membranes through the formation of new phospholipids (Ceraxon, Piracetam).
6. Vitamins. To improve brain and physical activity, as well as prevent complications, vitamin complexes are prescribed. They should include vitamins B, C, A, E.
7. Dietary supplements. Dietary supplements are indicated for the treatment of the consequences of stroke after a course of conservative therapy. These include Papaya Attiva, ASD second faction, Tianshi. A contraindication to their use is the period of exacerbation of the condition.

Note! For post-stroke rehabilitation, physiotherapeutic procedures using special devices are prescribed. Their action is aimed at restoring brain and motor activity and preventing relapses

During the recovery period, the patient must follow a special regimen. The diet after an ischemic stroke excludes from the menu fried, fatty and spiced dishes, a large number of sweets and baked goods made from premium flour. Instead, you need to eat enough seasonal vegetables and fruits, lean meats and poultry, and drink a lot of clean water.

In order for the body’s recovery to take place most fruitfully, the patient must be surrounded with care and ensure timely administration of medications for stroke. In the absence of physical and psychological discomfort, he will be able to tune in to obtain positive results.